CM

Asthma
Asthma

>1 /
>1 /

>=1 /
>2 /

<1 /
<=2 /

%
<=60
60-80
>=80
>=80

Asthma

( 200- ( 400400mcg)
800mcg)
Triamcinolone
4-10 puffs
10-20 puffs
(100mcg/puff)
Beclomethasone 4-12 puffs
12-20 puffs (42mcg)
dipropionate
(42mcg)
6-10 puffs (84mcg)
(Beclomet) (42, 2-6 puffs (84mcg)
84 mcg/puff)
Budesonide
1-2 inhalations
2-3 inhalations
Turbuhaler
(Pulmicort
turbuhaler)
(DPI: 200
mcg/dose)
Flunisolide
2-4 puffs
4-8 puffs
(250mcg/puff)
Fluticasone
2-6 puffs(44mcg)
2-6 puffs(100mcg)
(MDI: 44, 110,
2 puffs(110mcg)
3-6 inhalations:
220 mcg/puff)
2-6 inhalations:
(100mcg)
DPI: 50, 100, 250
(50mcg)
mcg/dose
DPI: dry power inhaler; MDI: metered-dose inhaler

Asthma

Prednisolone
5mg/tab
Methylprednosolone
IV: 1255001000 mg/vial
(mednin)(solu-medrol) PO: 4mg/tab
Hydrocortisone (solu- IV: 100500 mg/vial
cortef)
Dexamethasone

IV: 5mg/1mL/vial

PEF
%
>30
>30
20-30
<20

( 8001200mcg)
>20 puffs
>20 puffs (42mcg)
>10 puffs (84mcg)
>3 inhalations

>8 puffs
>6 puffs(100mcg)
>3 puffs(220mcg)
>6 inhalations(100mcg)
>2 inhalations(250mcg)

30-40 mg/day60-80 mg/day

(Decadron)

PO: 0.5 mg/tab

MTP ( mineralosteroid )
Theophylline(IV)(Theophylline)
Loading dose:
theophylline5 mg/kg over 20mins
theophylline theophylline 3
mg/kg over 20mins
theophylline 1mg/kg bolus theophylline
2g/mL
Maintain dose(mg/kg/hr):
0.6
0.4
0.2
(cor pulmale)0.2
0.3
0.2
0.2
800mg Theophylline 500mL D5W NS =1.6mg/mL
Loading dose: 5 mg/kg over 20minsMaintain dose(mg/kg/hr): 0.2-0.6 mg/kg/hr

Theophylline(PO)( Aminophylline Theophylline)

Phyllocontin 225
Aminophylline
Tablet
mg
Controlled-released
Theolan 200mg,
Theophylline
Capsule
300mg
Sustained-released
Xanthium
Theophylline
Capsule
200mg, 400mg
Sustained-released
Euphyllin 175mg,
Theophylline
Tablet

225 mg bid
200-300 mg qd
400-600 mg qd
350 mg bid-tid

350mg
Uniphylline
200mg, 400mg

monohydrate
ethylenediamine
Theophylline

Retard
Tablet
Sustained-released

600-800 mg qd

theophylline 400-600mg/day 100-200mg

8-12 mg/L=

-agonist

(min) (hr)
MDI: 0.2 mg/puff
1-2 puffs bid-qid
Fenoterol
5
3-6
Solu: 5 mg/ml
0.5 ml qd-qid
(Berotec)
5
3-6
PO: 2.5 mg/tab
1.25-2.5 mg tid
30-60
6-7
MDI: 0.25 mg/puff
1-2 puffs bid-qid
Terbutaline
5-30
3-6
Powder: 0.5 mg/puff
1-2 puffs bid-qid
(Bricanyl)
5-30
3-6
Solu: 5mg/2ml/vial
1-2 ml qd-qid
30-45
6-8
PO: 2.5mg/tab

2.5-5 mg tid

Salbutamol
(Volmax)
(Ventolin)
(Buventol)

MDI: 0.1mg/puff
Powder: 0.2 mg/puff

1-2 puff bid-qid

1-2 puff bid-qid

Solu: 5mg/2.5ml/vial

1 vial qid

PO: 2mg/tab,

2-4 mg tid-qid

Hexoprenaline
(Ipradol)
Procaterol
(Meptin)
Salmeterol
(Serevent)
Bambuterol
(Bambec)

MDI: 0.2mcg/puff
PO: 0.5mg/tab

1-2 puffs bid-qid

0.5mg tid

MDI: 10 mcg/puff
PO: 50mcg/tab, 25mcg/tab

1-2 puffs qd-tid

50mcg bid

MDI: 25mcg/puff

2 puffs bid

PO: 10 mg/tab

10-20 mg qd

4mg/CR tab

Anti-cholinergic

Ipratropium
(Atroven)
Atropine sulfate
Ipratropium and
Fenoterol
(Berodual)
Ipratropium and
Salbutamol

<15
<15
<15
15-30

3-6
3-6
3-6
8

1-5
30-60
2-5
30
5-10

3-8
4
6-8
8-12
12

(min)
3-15

(hr)
4-6

4-8 mg bid

MDI: 20mcg/puff
Solu: 0.25 mg/ml

2-4 puffs tid-qid

1-2 ml qid

UDV: 0.5mg/2ml/vial

1vial qid

Solu: 5 mg/ml and 2mg/ml

MDI: Ipratropium: 20 mcg
Fenoterol: 50 mcg

2.5 mcg/kg tid-qid

1-2 puffs tid

15
3-5

3-5
6-8

MDI: Ipratropium: 20 mcg

Salbutamol: 100 mcg

2 puffs qid

3-5

6-8

(Combivent)

Asthma
(PEF)
FEV1 X


aVentolin IH q20mins
b 90%( 95%)
c
(Methylprednisolone 60-125mg IV q4-6h
Hydrocortisone mineralocorticoid )
d

PEF

aPEF 60%
b
c
d
e() -agonists
Ipratropium)
a
(Methylprednisolone 40-60mg IV Q6H
Prenisolone 60mg IV Q6-8H, 36-48
)
b Anticholinergic
drug

a
60
b
cPEF>70%

d
e 90%
( 95%)

cPEF 60-80%
d

e 60 agonists
f
g 1-3

1
a

cPEF 30%
dPCO2 45 mmHg
f PO2 60 mmHg

1-2
a

cPEF 50%-70%
d


a agonists
b

a -agonists
Ipratropium
b
c
d
Aminophylline
e PEF

theophylline

a -agonists
Ipratropium
b
c
Ventolin
d
e
Aminophylline
f

PEF 70%

6-12

Asthma

(
)(PSAsthma NSAIDs)

-agonists 1

-agonists

()
200-400mcgintalnedocromil
()
-agonists anti-cholinergics
Anti-Leukotriene

-agonists 4

()
400-800mcg
-agonists
-agonists

-agonists 4

()
800-1200mcg
-agonists Anti-Leukotriene

-agonists 4

COPD(Chronic bronchitis and Emphysema)

Chronic bronchitis >3
Emphysema
aucte exacerbations
1()
2Albuterol (Ventolin) q20-30 mins

3Ipratropium bromide (Atroven) 2 puffs qid 4-6 puffs q4-6hr

4MTP(methylprednisolone) 125mg IV q6h for 3 days
5Theophylline (?)
6Antibiotics
aS. pnuemoniae, H. influenza, M. pneumoniae
bBaktar 160/800mg PO bid,
Amoxicillin 250mg PO tid,
Doxycycline 100mg PO bid
cAzithromycin 500mg for one day, and 250mg for 2nd-5th day
Clidamycin 500mg PO qd
Levofloxacin 500mg PO qd
Gatifloxacin 400mg PO qd

1
2Ventolin 2 puffs bid, Atroven 2 puffs q4-6h, oral theophylline
3
4
5S. pnuemoniae H. influenza
6Psychoactive drug: Buspirone 5-10 mg PO tid ()
71-protease inhibitor augmentation therapy 60 mg/kg
(>600cc/24hr
100cc)
1Monitor vital sign, O2 saturation
2()
3NPO
4CBC, ABG, PT, aPTT, electrolyte, blood typing, cross-matching , RFT and LFT
5codeine 1# st and q6h
6Antifibrinolytic agents: plaslloid or transamine
7 CT bronchoscopy
8Bronchial artery embolization(BAE)
9 Double lumen, ETT
10

URI
COPD Bronchogenic carcinoma
ACEICXR Post-nasal drip, Asthma, GERD

1ACEI, -blocker, NSAIDs, Anti-cholinergics, Tryptophan,

Amiodarone,
2
3 X
4Post-nasal drip, Asthma, GERD
5HRCTBaEBronchoscopy
6 psychogenic cough

Opioid Opioid codein

1Opioid
1 Codein 0.5# QID PO, 1amp IM st (,)
2 Hydrocodone 5-10 mg PO q4-6h
3 Hydromorphine 1mg PO q3-4h
2 Opioid
1 Dextromethorphan 10-20 mg PO q4-6h
i.
Medicon 1# tid PO ()
ii.
Regrow 1# qd PO ()
2 Benzonatate 100 mg tid PO

Ciliated epithelial cell([]), Cilia (-), Aquaous(/), Gel(|)

[]--///// |||
[]-////// |||
1Expectorant (Aquaous)
Guaifenesin (Guaphen Syrup) 10-20ml q4h
Iodopropylidene glycerol (Mucora) 1# tid
Ambroxol (Mucosolvent) 1# tid
Cilia

NoteGuaifenesin
2Mucolytic (Gel layer)
1 Thiol
Bromhexine(Bisolvent) 1# tid PO or 4ml bid IH
Acetylcysteine(Actein) 1 wp TID po
S-S bond ( DNA)


NoteThiol Cilia
2 Enzyme
Carbocysteine(Muco-treis) 1# tid PO
Serratiopeptidase(Danzen) 1# tid PO
()

Note
TB

Isoniazid (INH)

100 mg

Rifampin (RIF)

300 mg

Pyrazinamid(PZA)

500 mg

Ethambutol (EMB)

400 mg

(60 )
5 mg/kg
(300 mg, 3# QD)
10 mg/kg
(600 mg, 2# QD)
25 mg/kg (1500 mg,
1# BID-TID)
15 mg/kg
(900 mg, 2#QD)
0.75-1 g IV

Uremia

1/2

1/2

*(INH + RIF + PZA + EMB) X 2 month + (INH + RIF + EMB) X 4 month

* Vit B6 50mg (1# QD)
*RIFINHPZAEMB
*DM TB DM
EMB DM TB EMB
* TB Pleural Effusion
TB (TB )
* Streptomycin, Quinolone(Levo>Max), PAS,
TBN( INH ) 18
* INH *6

Streptomycin(STM)

LDH

Lights criteria:
Pleural fluid protein/ serum protein >0.5
Pleural fluid LDH/ serum LDH >0.6
Pleural fluid LDH LDH 2/3

Exudate

Transudate
CHFcirrhosisnephrosis

PF-glucose, amylase
PF-cytology
differential cell countculturestain PF

Amylase

60 mg/dL

()
-

-
PPD test
-

1PH<7.3 complicated parapneumonic effusion or empyenma, TB,

malignancy, collagen-vascular disease, esophageal rupture, systemic acidosis
2 40 mg/dL empyema, rheumatoid arthritis, TB, malignancy
3Amylase pancreatic disease, malingnacy, esophageal rupture, Rneal F

4 PMNs CXR Parapneumonic

effusion ( bronchogenic carcainoma obstructive pneumonitis
effussion), pulmonary embolism
5 PMNs CXR pulmonary
embolism, viral infection, GI disease, asbestos pleural effusion, malignant pleural
effusion, or acute tuberculosis pleuritis
6 lymphocyte malignancy, TB, or pulmonary embolism
Parapneumonic effusion and empyema

Typical
PH>7.2
Negative

parapneumonic LDH<1000 IU/L

effusion
Glu>40 mg/dl
Complicated
PH 7.0-7.2
Negative
24
parapneumonic LDH>1000 IU/L

effusion

Glu>40 mg/dl
---borderline
Complicated
PH<7.0
Gram-stain (+)
parapneumonic LDH>1000 IU/L Culture (+)

effusion
Glu<40 mg/dl
No frank pus
---simple
or loculated
Complicated
PH<7.0
Gram-stain (+)
parapneumonic LDH>1000 IU/L

Culture (+)
effusion
Glu<40 mg/dl
Loculated, but thrombolytic agent
---complex
( sunction)
no frank pus
Empyema
Free-flowing

---simple
frank pus in a
single loculus
empyema
decortication
Empyema
Multiloculated
---complex
frank pus

thrombolytics
decortication

1 lobule thrombolytics simple

2Thrombolytics Urokinase 100, 000U + NS 500c.c
lidocaine

Lung abscess
1

2( cavity close)
1 Crystal PCN 1.5-2 million unit IV q4h Clidamycin()
2 PCN VK500 mg PO q6h or Clidamycin 300-450mg PO tid
3

1 bronchoscope
2Chemical pneumonitis intestinal obstruction, gingivitis, periodonitis

3Aspiration pneumonia
PCN, Augmentin, Clindamycin
Unasyn/Augmentin + Fluoroquinolone
Cephalosporin + Clindamycin
Imipenem/Meropenem
Bronchiectasis()
1
2
3
TB
Amoxicillin or Ampicillin

Approach to Solitary pul. nodule

1Hx: age, smoking, occupation, prior malignancy
2CXR and CT:
1 size: >3cm
2 shape: corona radiata(), smooth border(), tail sign(), satellite()
3 calcification:
i.
diffuse, laminated, central:
ii.
popcorn: Harmatoma

iii.
concentric(laminated): TB, Fungus, granulomas
iv.
cental dense nidus: granulomas
v.
eccentric:
4 cavitation: >15mm(), <4mm()
5 Air-bronchogram
6 Doubling time: small(30days)squamous, large(60days)adeno(120days)
7 contrast: enhancement()
8 others: LN, rib destruction ()
3
1 biopsy: sono-guided, bronchoscope, open lung biopsy
2 sputum cytology * 6sets, positive rate: 75%

1NSCLC
1 stage I-II lobectomy + radical LN dissection
2 stage IIIA(T1-3, N2) OP or RT
3 stage IIIB(T4 or N3) RT, if malignant pleural effusion is present, use CT
4 stage IV(M1) CT
PS: T4 N3
2SCLC
1 limited stage: CT(VP16+cisplatin), RT
2 extensive stage: CT(VP16+cisplatin), RT
3ApproachSputum cytologyBronchoscopic brushing and biopsyTransthoracic
needle aspirationVedio-assisted thoracoscopic surgery(VATS)Open lung biopsy
ARDS
1
2PaO2/FiO2<200
3 HF Fluid overload

1>25mmHg>30mmHg
2
1 Lasix(Fluid overload )
2 VasodilatorEpoprostenol(Prostacyclin), adenosine(IV), CCB(PO),
NO(IH) nifedipine 30-240 mg /day diltiazem 120900mg /day
3 Warfarin INR=2
4 Heart-Lung transplantation

Respiratory failure
Oxygen failurePaO2<60, PaCO2<40()
Ventialtion failurePaO2<60, PaCO2>50()
Pleurodesis
Minocycline 300mg + NS 50cc
Mitomycin 8-10mg + NS 50cc
Picibanil 10KE + NS 50cc
Bleomycin 30-60mg + NS 50cc